Because opportunities for family assessment and intervention are often limited, it is important to employ efficient procedures and to have clarity about who conducts the assessment.
Who Is the Family Therapist?
DBT teams typically include three or more people, often with multiple roles on the team: skill trainer, individual therapist, peer supervisor, skills coach. We will assume that the family therapist also conducts the family assessment, and simply refer to that person as the family therapist, because family assessment and family therapy are so interwoven. This is another role that needs to be incorporated into the team.
Obviously, in this DBT team context, there are two options: the individual therapist can also be the family therapist; or, a different team member can serve as the family therapist. Although people often have strong opinions about the need to do it one way or the other, there are no data to support one structure versus the other. It is important for all participating members to agree to open discussion in sessions about all relevant issues. Ethically, of course, any adult can terminate permission to disclose or discuss private information, so it is important to get a clear agreement keeping communication open. We believe that there are no inherent “dual role” problems when the therapist and team opt for the individual therapist also to provide couple or family interventions. Of course, the therapist needs to be clear about treatment targets (below), and that the therapist is working to improve both the couple/family relationship and the well-being of all individuals in those relationships, in typical dialectical (DBT) fashion (see Thorp & Fruzzetti, 2003, for a fuller discussion of ethical issues and practices in couple/family therapy).
In practice there are pros and cons for both options (individual therapist also providing couple/family interventions vs. having a separate couple/family therapist; Fruzzetti, 2018). For example, some of the pros of having the individual therapist also be the couple/family therapist include: (a) the therapist will have more awareness of the individual client’s problems and prior chains (and solutions), and may be able more effectively to intervene earlier on the chain if problematic transactions emerge in-session; and (b) the therapist will likely be more facile in motivating the individual client in couple/family sessions (e.g., may be able to push harder for change, and/or more efficiently validate). On the other hand, some of the pros of having a different DBT team member take the role of the family therapist include: (a) it may seem more balanced (or simply preferable) to partners or parents that the couple/family therapist be dedicated to this role only, and (b) having an additional person participate directly with the family may provide more helpful perspectives for the DBT consultation team to consider. (Note: some teams choose to have the individual therapist also provide family therapy, but have a different therapist provide parent or partner skill coaching.)